Biventricular

Biventricular refers to involving or affecting both ventricles of the heart. In medical use, the term is most often encountered in relation to heart failure and pacing therapies that aim to coordinate the contractions of the right and left ventricles to improve cardiac function.

Biventricular pacing, also known as cardiac resynchronization therapy (CRT), is a form of therapy designed to restore synchrony between the two ventricles. It typically uses a device implanted under the skin with leads placed in the right atrium, the right ventricle, and a lead delivered through the coronary sinus to the left ventricle. By timing electrical stimuli to a common beat, CRT can improve the efficiency of the heart’s pumping action.

Indications for biventricular pacing generally include symptomatic heart failure with reduced ejection fraction and a widened QRS complex on electrocardiography, often with left bundle branch block. Candidates are usually receiving optimal medical therapy but remain limited by functional status or frequent hospitalizations. Not all patients respond to CRT, and effectiveness depends on factors such as scar burden, anatomy, and underlying heart condition.

Risks are those associated with any implanted device and include infection, lead dislodgement or failure, venous thrombosis, and inappropriate device shocks in the case of CRT-defibrillators. CRT devices may be used as pacemakers (CRT-P) or combined with a defibrillator (CRT-D).

Historically, CRT emerged in the late 1990s and has since become a standard option for selected patients with heart failure and electrical dyssynchrony.